ANCC NE-BC Exam Questions

Page 8 of 20

141.

A nurse executive is evaluating strategies to improve staff satisfaction in a high-turnover unit. Which approach is most aligned with the ANA Nursing Administration Scope and Standards of Practice?

  • Facilitating professional development and leadership opportunities.

  • Implementing increased overtime opportunities to maintain adequate staffing levels.

  • Offering competitive salary packages to attract new staff.

  • Reducing the patient-to-nurse ratio.

Correct answer: Facilitating professional development and leadership opportunities.

Professional development and leadership opportunities align with the ANA's emphasis on fostering professional growth and a healthy work environment. This intervention is most likely to positively impact staff satisfaction.

Increasing overtime may temporarily solve staffing issues but it can lead to burnout and dissatisfaction. Reducing staff turnover should be the long-term focus. While important, salary alone may not improve satisfaction. Additionally, efforts should be focused on retention, not recruitment, when there is high staff turnover. Reducing patient-to-nurse ratios could improve satisfaction but this can be achieved by other interventions, as reducing the ratios is not a practical strategy by itself.

142.

During a routine compliance audit, a nurse executive identifies a gap in adherence to the Health Insurance Portability and Accountability Act (HIPAA). Which of the following actions would best ensure patient information privacy and security?

  • Limiting access to patient records based on job roles.

  • Regularly updating computer antivirus software.

  • Conducting annual HIPAA training sessions for all staff.

  • Using encrypted email for all patient communication.

Correct answer: Limiting access to patient records based on job roles.

Limiting access to patient records based on job roles is a key requirement of HIPAA to ensure that only those who need to know have access to protected health information.

While important, updating antivirus software does not directly address the specific requirements of HIPAA regarding access to patient information. Annual training is important for awareness, but practical measures like access limitation are more directly impactful on a day-to-day basis. Using encrypted emails addresses the security of information in transit, however, limiting access to information tackles the broader issue of information privacy and security within the facility.

143.

A nurse executive is planning to integrate Evidence-Based Practice (EBP) into all levels of nursing care. Which action would be most effective in achieving this goal?

  • Organizing regular EBP workshops and providing resources for staff.

  • Conducting annual performance evaluations focused on EBP.

  • Creating a task force to review and update existing nursing policies.

  • Decreasing direct patient care work for nurses to allow them more time for research.

Correct answer: Organizing regular EBP workshops and providing resources for staff.

Regular workshops and accessible resources empower nurses with the knowledge and skills to apply EBP, fostering a culture of continuous improvement.

While performance evaluations are important, they are not as effective in educating staff about EBP as ongoing workshops and resources. Reviewing and updating policies is important but it does not ensure staff are educated or skilled in implementing EBP. Giving nurses more time to research EBP on their own does not directly facilitate the integration of EBP into practice and may not be an efficient use of human capital.

144.

A nursing executive is planning to reduce medication errors on their unit. Which of the following steps should they perform first according to the PDSA cycle?

  • Analyze the current rate and types of medication errors occurring on the unit.

  • Implement a new bar-code medication administration system across the unit.

  • Hold a meeting with the nursing staff to review recent medication errors following the implementation of a new process.

  • Adjust the medication administration protocol based on feedback from nursing staff.

Correct answer: Analyze the current rate and types of medication errors occurring on the unit.

The "Plan" phase of the PDSA (Plan-Do-Study-Act) cycle emphasizes the importance of understanding the current situation before making changes. Analyzing the current rate and types of medication errors allows for identifying specific areas of improvement and setting a baseline for measuring the impact of any interventions.

Implementing a new bar-code medication administration system across the unit represents the "Do" phase, where changes are implemented after planning. Holding a meeting with the nursing staff is part of the "Study" phase, focusing on evaluating the effects of the changes made. Adjusting the protocol based on feedback represents the "Act" phase, where adjustments are made based on the evaluation of the change.

145.

To decrease the time from admission to initial assessment in the emergency department, a nurse executive employs lean principles to streamline the process. Which step indicates the application of the "Eliminate Waste" lean principle?

  • Removing redundant paperwork required for patient admission.

  • Hiring additional triage nurses to avoid wasting time when assessing patients upon arrival.

  • Implementing an electronic patient tracking system to save time.

  • Increasing the number of available patient beds in the emergency department to improve workflows.

Correct answer: Removing redundant paperwork required for patient admission.

Removing redundant paperwork directly applies the "Eliminate Waste" principle of lean by eliminating non-value-added activities from the process, thus streamlining the admission process and reducing the time to initial assessment.

Hiring additional triage nurses addresses capacity but does not directly eliminate process waste. Implementing an electronic patient tracking system improves efficiency and tracking but is not specifically focused on waste elimination. Increasing the number of beds addresses a different aspect of capacity and does not focus on waste elimination in the process.

146.

During a team meeting, a nurse executive notices a heated argument between two team members about the allocation of patient assignments. Which strategy should the nurse executive use to facilitate effective conflict resolution in this situation?

  • Facilitate a solution-focused discussion that encourages compromise and mutual understanding.

  • Implement a new policy for patient assignment distribution to eliminate future conflicts.

  • Encourage the team members to continue their discussion until they reach a consensus.

  • Assign patient care duties based on seniority to quickly resolve the dispute.

Correct answer: Facilitate a solution-focused discussion that encourages compromise and mutual understanding.

Facilitating a discussion that focuses on solutions, compromise, and understanding addresses the conflict constructively and promotes a positive team environment.

Implementing a new policy may be excessive for a situational conflict and does not immediately address the underlying conflict. Allowing the argument to continue without intervention may not lead to a productive resolution and could harm team cohesion. Using seniority as the basis for assignments may not be fair or appropriate for patient needs and does not resolve the conflict.

147.

What strategy is most effective in fostering a culture of engagement among nursing staff?

  • Implementing an open-door policy for all management levels.

  • Increasing salary and benefits across the board.

  • Assigning additional responsibilities to high-performing staff.

  • Implementing all ideas provided by nursing staff.

Correct answer: Implementing an open-door policy for all management levels.

An open-door policy encourages communication, trust, and transparency between staff and management, which are key to engagement.

While compensation is important, it does not directly foster engagement or address intrinsic motivational factors. Assigning additional responsibilities without support or recognition can lead to burnout rather than engagement. While implementing ideas provided by nursing staff can promote engagement by demonstrating that staff’s ideas are being taken seriously, implementing all ideas provided by nursing staff without fully considering their potential impacts is not ideal.

148.

A nurse executive is evaluating the effectiveness of a new safety protocol in reducing medication errors on a busy surgical unit. Which of the following measures would be most indicative of a positive safety culture?

  • An increase in the reporting of near-misses.

  • A decrease in the reports of any kind of medication errors.

  • A reduction in patient complaints relating to medication.

  • A reduction in the amount of medications administered.

Correct answer: An increase in the reporting of near-misses.

An increase in the reporting of near-misses reflects an environment where staff feel safe to report errors and near-misses, a key aspect of a positive safety culture.

A decrease in the reports of any kind of medication errors may be caused by a decreased reporting of errors rather than an actual decrease in errors. A reduction in patient complaints may indicate improved patient satisfaction but doesn't directly measure safety culture. A reduction in the amount of medications administered does not indicate a decreased risk of error associated with medication administration.

149.

A nurse executive evaluates a policy that restricts nurses from discussing patient cases on social media. Which ANA Code of Ethics principle supports this policy?

  • Nonmaleficence

  • Justice

  • Autonomy

  • Beneficence

Correct answer: Nonmaleficence

Nonmaleficence, the principle of doing no harm, directly supports restricting discussions that could compromise patient privacy and safety.

Justice, the principle of equity in care, is important but does not directly justify the restriction on social media discussions. Autonomy allows for personal decisions but these must be balanced with professional responsibilities. Beneficence focuses on positive actions that benefit patients and is not as directly related to the restrictive policy as nonmaleficence.

150.

A nursing home adjusts its staffing model and classifies all its Registered Nurses (RNs) as exempt employees to avoid paying overtime. The RNs work an average of 50 hours a week. Under the Fair Labor Standards Act (FLSA), which statement best describes the legality of this action?

  • Illegal, unless the RNs are primarily engaged in executive, administrative, or professional duties as defined by the FLSA.

  • Legal, if the RNs receive a salary above the minimum threshold for exempt employees.

  • Legal, as long as the RNs agreed to the exempt status upon hiring.

  • Illegal, because nurses cannot be classified as exempt under any circumstances.

Correct answer: Illegal, unless the RNs are primarily engaged in executive, administrative, or professional duties as defined by the FLSA.

The exemption status under the FLSA depends on the employee's actual job duties and salary. Nurses can be exempt if their primary duties fall under the executive, administrative, or professional categories and they meet the salary threshold.

Simply paying a salary above the minimum threshold does not automatically qualify an employee for exempt status; the nature of their job duties also matters. Agreement by the employee does not affect the legal classification under the FLSA; it is determined by job duties and salary. Nurses can be classified as exempt if they meet the specific criteria for exemptions under the FLSA.

151.

A nurse executive is developing a program to enhance compliance with the Centers for Medicare & Medicaid Services (CMS) standards. Which initiative would most effectively reduce readmissions for heart failure patients?

  • Implementing a standardized discharge planning protocol.

  • Increasing the nurse-to-patient ratio on cardiac units.

  • Offering monthly heart health educational seminars for patients.

  • Expanding access to outpatient cardiac rehabilitation programs.

Correct answer: Implementing a standardized discharge planning protocol.

Standardized discharge planning protocols have been shown to effectively reduce readmissions by ensuring patients understand their care plan, follow-up appointments, and self-care practices after discharge.

While increasing the nurse-to-patient ratio can improve patient care, it does not directly address the factors contributing to readmissions for heart failure patients. General educational seminars provided every month can be beneficial for patient engagement and knowledge, but they do not directly reduce readmissions as effectively as a standardized discharge planning protocol would. Outpatient cardiac rehabilitation programs support recovery, but implementing a standardized discharge protocol directly addresses the transition from hospital to home, which is more important for preventing readmissions.

152.

Following a large-scale natural disaster, what should be the initial step taken by the nurse executive to ensure adequate staffing?

  • Assess the current staffing levels and projected needs.

  • Request volunteers from non-affected areas.

  • Implement immediate mandatory overtime for all staff.

  • Activate an emergency contract with a staffing agency.

Correct answer: Assess the current staffing levels and projected needs.

Initially assessing current staffing levels and projected needs ensures that any subsequent actions are informed and targeted.

While requesting volunteers is important, it should come after understanding staffing needs. Implementing mandatory overtime may be necessary but only after an assessment of needs and available resources is completed. Activating a contract with a staffing agency could be a viable long-term option, but it should follow an initial assessment of staffing requirements.

153.

A nurse executive is reviewing patient satisfaction surveys to identify areas for improvement. Which of the following actions is most likely to enhance the overall patient experience based on survey feedback indicating a need for more compassionate care?

  • Implementing a training program on empathy and communication skills.

  • Increasing the number of staff in the facility.

  • Notifying nurses of the results of the survey and encouraging an increased emphasis on empathy.

  • Gathering more data on how patients perceive the level of compassion of the staff.

Correct answer: Implementing a training program on empathy and communication skills.

Training on empathy and communication directly targets the feedback for more compassionate care, equipping staff with the skills to enhance patient interactions.

Simply increasing staff numbers may not address the specific need for more compassionate care. Notifying nurses of the results of the survey and encouraging an increased emphasis on empathy is not as likely to be as effective as providing training on empathy and communication. Gathering more data on how patients perceive the level of compassion of the staff is unnecessary if actionable data already exists and may delay the resolution of the problem.

154.

According to the Americans with Disabilities Act (ADA), how should employers treat employees with disabilities in terms of job performance?

  • Employees with disabilities must meet the same performance standards as their coworkers, with or without reasonable accommodations.

  • Employees with disabilities should be held to a lower standard of performance.

  • Employees with disabilities are exempt from regular performance evaluations.

  • Employers must automatically adjust performance standards for employees with disabilities using the matrix provided in the ADA.

Correct answer: Employees with disabilities must meet the same performance standards as their coworkers, with or without reasonable accommodations.

The ADA requires that employees with disabilities meet the same performance standards, given reasonable accommodations if needed.

Employees with disabilities are not exempt from performance evaluations. The ADA does not advocate for lower standards for employees with disabilities. The ADA also does not include a matrix for automatic adjustments in performance standards.

155.

During a period of significant organizational change, a nurse leader notices an increase in staff anxiety. Which communication strategy should the leader employ to address this issue?

  • Holding regular update meetings to discuss changes and address concerns.

  • Limiting the amount of information shared to prevent further anxiety.

  • Only communicating changes after they are in the implementation stage.

  • Relying on informal networks to disseminate information about changes to improve staff comfort.

Correct answer: Holding regular update meetings to discuss changes and address concerns.

Regular meetings provide a forum for transparency, allowing staff to express concerns and receive direct feedback, which can alleviate anxiety.

Withholding information can lead to rumors and increase anxiety. Communicating changes during or after implementation does not allow staff to prepare or adapt, potentially increasing resistance and anxiety. Informal networks are unreliable and can lead to misinformation, further exacerbating anxiety and uncertainty.

156.

A nurse executive learns that several nurses are organizing a union. In response, the nurse executive plans to hold a meeting to discourage the nurses from joining. They intend to explain the disadvantages of unionization and how it could negatively impact their working relationship. According to the National Labor Relations Act (NLRA), which statement is true regarding the nurse executive's planned action?

  • It is legal, as long as the executive does not make any threats or promises of benefits.

  • It is illegal because it intimidates nurses who are considering organizing a union.

  • It is only legal if the meeting is voluntary and not during paid working hours.

  • It is illegal because it constitutes direct interference in union activities.

Correct answer: It is legal, as long as the executive does not make any threats or promises of benefits.

Employers are allowed to express their views on unionization to their employees as long as they do not engage in coercive actions, such as threats of reprisal or promises of benefits, which would violate the NLRA.

Simply holding a meeting to discuss the disadvantages of unionization is not in itself intimidation, provided it is done without coercion. The legality of the meeting does not hinge solely on it being voluntary or held during non-working hours; the critical factor is the absence of threats or promises. While direct interference in union activities is illegal, employers are permitted to communicate their stance on unionization in a non-coercive manner.

157.

Which scenario represents a violation of the Americans with Disabilities Act (ADA) in a healthcare setting?

  • A qualified nurse who is deaf is not hired because the hiring manager believes patients may feel uncomfortable.

  • A qualified nurse with a temporary injury is given modified duties until she can return to her regular responsibilities.

  • An employee with diabetes is allowed to take additional breaks but is only allowed to monitor blood sugar levels and administer insulin during these breaks.

  • A nurse is provided with voice recognition software to assist with documentation due to her carpal tunnel syndrome.

Correct answer: A qualified nurse who is deaf is not hired because the hiring manager believes patients may feel uncomfortable.

Choosing not to hire a nurse who is qualified for the position because they are deaf represents discrimination based on assumptions about the nurse's disability and patient comfort, which is prohibited by the ADA.

Providing modified duties for an employee with a temporary injury can be considered a reasonable accommodation. Providing extra breaks that are limited in scope but allow the necessary care of a disability is permissible. Using voice recognition software to assist with documentation is an example of a reasonable accommodation that complies with the ADA.

158.

A hospital implements a policy that all nurses must clock in no more than seven minutes before their scheduled shift starts and must clock out no later than seven minutes after their shift ends to avoid unauthorized overtime. A group of nurses frequently starts work 15 minutes early to ensure a smooth shift change. According to the Fair Labor Standards Act (FLSA), how should this time be compensated?

  • As overtime, if adding these minutes results in more than 40 hours worked in a week.

  • As regular time, even if these minutes result in more than 40 hours worked in a week since the nurses choose to come in early without direct instruction.

  • Not compensated, because the time worked was unauthorized.

  • As volunteer time, since it is less than 30 minutes beyond the scheduled shift.

Correct answer: As overtime, if adding these minutes results in more than 40 hours worked in a week.

Any hours worked over 40 in a workweek must be compensated at the overtime rate, even if the work was not authorized or was in violation of policy.

The FLSA requires that all time worked be compensated, whether or not the work was authorized in advance. The FLSA does not allow employers to avoid paying for work performed, even if it was unauthorized. Employers may discipline employees for violating policies but must pay for all hours worked. The FLSA does not recognize volunteer time for employees in for-profit sectors; all time worked must be compensated.

159.

Which scenario best illustrates a healthcare organization with an effective commitment to a culture of safety?

  • A nursing home that conducts root cause analyses for near-misses and errors without assigning blame.

  • A hospital that reduces medication errors by penalizing nurses involved.

  • A clinic that reviews all adverse events thoroughly on a quarterly basis.

  • A healthcare system that focuses on individual accountability for errors.

Correct answer: A nursing home that conducts root cause analyses for near-misses and errors without assigning blame.

Conducting root cause analyses for near-misses and errors without assigning blame encourages openness and focuses on systemic improvements rather than individual blame.

Penalizing nurses for medication errors does not foster a culture of safety and may lead to underreporting. Infrequent reviews of adverse events, such as reviewing on a quarterly basis, may not adequately address or prevent safety issues in a timely manner. Focusing on individual accountability rather than system-wide improvements does not promote a holistic approach to enhancing safety.

160.

When implementing a new Electronic Health Record (EHR) system, what is the most critical factor to consider for maintaining compliance with the Health Insurance Portability and Accountability Act (HIPAA)?

  • The system's ability to encrypt patient data.

  • The technological complexity the EHR system is designed around.

  • The ease of use for healthcare providers.

  • The ease of accessing the user interface.

Correct answer: The system's ability to encrypt patient data.

Encryption of patient data is essential for protecting patient information from unauthorized access, making it a critical factor for HIPAA compliance.

While technological complexity is a consideration and may be applied to encryption, it does not necessarily directly impact HIPAA compliance itself. Ease of use is important for operational efficiency but secondary to ensuring the security and confidentiality of patient data as required by HIPAA. The ability to access the user interface is tangentially related to HIPAA compliance, but it is not as important a factor as the encryption of patient data, which can be accessed in other ways than the user interface.